Provider Demographics
NPI:1417348657
Name:MCKENZIE, AMBER D (RN, FNP)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:D
Last Name:MCKENZIE
Suffix:
Gender:
Credentials:RN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 211699
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55121-3699
Mailing Address - Country:US
Mailing Address - Phone:866-849-0692
Mailing Address - Fax:
Practice Address - Street 1:20405 STATE HIGHWAY 249 STE 325
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-2893
Practice Address - Country:US
Practice Address - Phone:866-849-0692
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-10
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5021077363L00000X
MO2024046586363L00000X
SC29551363L00000X
COC-APN.0103188-C-NP363L00000X
TN37556363L00000X
KY4031218363L00000X
OH0037697363L00000X
FLAPRN11036321363L00000X
AR230626363L00000X
HIAPRN-4931363L00000X
OR10035087363L00000X
GAGAA-NP003108363L00000X
AZ319180363L00000X
TXAP127441363LF0000X
AL3-002209363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner